Skip to main content
SpringerLink
Log in

Evaluation of joint laxity against distal traction force upon flexion in cruciate-retaining and posterior-stabilized total knee arthroplasty

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Several studies have reported varus-valgus stability in the extension position after total knee arthroplasty (TKA). However, few studies have evaluated joint laxity in the flexion position postoperatively. The purpose of the study was to evaluate joint laxity against distal traction force on flexion after cruciate-retaining and posterior-stabilized total knee arthroplasties.

Methods

A total of 44 knees (22 knees cruciate-retaining, 22 knees posterior-stabilized) in 40 patients with osteoarthritis were tested in this study. The subjects were seated at a table and their knee joints were fixed at 80° of flexion to avoid overlapping images of condyles and the femoral shaft. Tibial shafts were adjusted to be parallel to the radiographic films, and posteroanterior radiographs were obtained. Flexion stress tests were performed with a distal traction of 100 N at a neutral foot position. Radiographs were obtained at neutral and traction positions. The distance from the perpendicular line of the top of the polyethylene insert to the midpoint on the tangential line of the femoral condyle was measured (joint space distance) at each side.

Results

In the flexion-neutral position, average joint space distances were 0.1 ± 0.2 mm in cruciate-retaining (CR) TKA knees and 0.2 ± 0.3 mm in posterior-stabilized (PS) TKA knees. With flexion-traction stress tests, the average joint space distances were 0.5 ± 0. 5 mm in CR TKA knees 2.4 ± 1.2 mm in PS TKA knees. Average changes of joint space distances between the two positions were 0.3 ± 0.4 mm (CR TKA) and 2.2 ± 1.5 mm (PS TKA). The changes in joint space distances between neutral and traction positions of PS TKA knees were significantly larger than those of CR TKA knees in flexion stress tests (P < 0.01).

Conclusion

The posterior cruciate ligament acted as a stabilizer against distal traction force in the CR-TKA knees. However, the laxity of PS-TKA knees against distal force differed among individual cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Laskin RS. Flexion space configuration in total knee arthroplasty. J Arthroplasty 1995;10:657–660.

    Article  PubMed  CAS  Google Scholar 

  2. Griffin FM, Insall JN, Scuderi GR. Accuracy of soft tissue balancing in total knee arthroplasty. J Arthroplasty 2000;15:970–973.

    Article  PubMed  CAS  Google Scholar 

  3. Dennis DA, Komistek RD, Walker SA, Cheal EJ, Stiehl JB. Femoral condylar lift-off in vivo in total knee arthroplasty. J Bone Joint Surg Br 2001;83:33–39.

    Article  PubMed  CAS  Google Scholar 

  4. Stiehl JB, Dennis DA, Komistek RD, Crane HS. In vivo determination of condylar lift-off and screw-home in a mobile-bearing total knee arthroplasty. J Arthroplasty 1999;14:293–299.

    Article  PubMed  CAS  Google Scholar 

  5. Nilsson KG, Kärrholm J, Gadegaard P. Abnormal kinematics of the artificial knee: roentgen stereophotogrammetric analysis of 10 Miller-Galante and five New Jersey LCS knees. Acta Orthop Scand 1991;62:440–446.

    Article  PubMed  CAS  Google Scholar 

  6. Yagishita K, Muneta T, Ikeda H. Step-by-step measurements of soft tissue balancing during total knee arthroplasty for patients with varus knees. J Arthroplasty 2003;18:313–320.

    Article  PubMed  Google Scholar 

  7. Andriacchi TP, Galante JO, Fermier RW. The influence of total knee-replacement design on walking and stair-climbing. J Bone Joint Surg Am 1982;64:1328–1335.

    PubMed  CAS  Google Scholar 

  8. Dorr LD, Ochsner JL, Gronley J, Perry J. Functional comparison of posterior cruciate retained versus cruciate-sacrificed total knee arthroplasty. Clin Orthop 1988;236:36–43.

    PubMed  Google Scholar 

  9. Ishii Y, Terajima K, Koga Y, Takahashi HE, Bechtold JE, Gustilo RB. Gait analysis after total knee arthroplasty: comparison of posterior cruciate retention and substitution. J Orthop Sci 1998;3:310–317.

    Article  PubMed  CAS  Google Scholar 

  10. Draganich LF, Pottenger LA. The TRAC PS mobile-bearing prosthesis: design rationale and in vivo 3-dimensional laxity. J Arthroplasty 2000;15:102–111.

    Article  PubMed  CAS  Google Scholar 

  11. Stein A, Fleming B, Pope MH, Howe JG. Total knee arthroplasty kinematics: an in vivo evaluation of four different designs. J Arthroplasty 1988;3(suppl):S31–S36.

    Article  PubMed  Google Scholar 

  12. Matsuda S, Miura H, Nagamine R, Urabe K, Matsunobu T, Iwamoto Y. Knee stability in posterior cruciate ligament retaining total knee arthroplasty. Clin Orthop 1999;366:169–173.

    Article  PubMed  Google Scholar 

  13. Nabeyama R, Matsuda S, Miura H, Kawano T, Nagamine R, Mawatari T, et al. Changes in anteroposterior stability following total knee arthroplasty. J Orthop Sci 2003;8:526–531.

    Article  PubMed  Google Scholar 

  14. Louisia S, Siebold R, Canty J, Bartlett RJ. Assessment of posterior stability in total knee replacement by stress radiographs: prospective comparison of two different types of mobile bearing implants. Knee Surg Sports Traumatol Arthrosc 2005;13:476–482.

    Article  PubMed  CAS  Google Scholar 

  15. Matsuda Y, Ishii Y, Noguchi H, Ishii R. Varus-valgus balance and range of movement after total knee arthroplasty. J Bone Joint Surg Br 2005;87:804–808.

    Article  PubMed  CAS  Google Scholar 

  16. Matsuda Y, Ishii Y, Noguchi H, Ishii R. Effect of flexion angle on coronal laxity in patients with mobile-bearing total knee arthroplasty prostheses. J Orthop Sci 2005;10:37–41.

    Article  PubMed  Google Scholar 

  17. Yamakado K, Worland RL, Jessup DE, Diaz-Borjon E, Pinilla R. Tight posterior cruciate ligament in posterior cruciate-retaining total knee arthroplasty. J Arthroplasty 2003;18:570–574.

    Article  PubMed  Google Scholar 

  18. Galinat BJ, Vernace JV, Booth RE Jr, Rothman RH. Dislocation of the posterior stabilized total knee arthroplasty: a report of two cases. J Arthroplasty 1988;3:363–367.

    Article  PubMed  CAS  Google Scholar 

  19. Sharkey PF, Hozack WJ, Booth RE Jr, Balderston RA, Rothman RH. Posterior dislocation of total knee arthroplasty. Clin Orthop 1992;278:128–133.

    PubMed  Google Scholar 

  20. Lombardi AV Jr, Mallory TH, Vaughn BK, Krugel R, Honkala TK, Sorscher M, et al. Dislocation following primary posteriorstabilized total knee arthroplasty. J Arthroplasty 1993;8:633–639.

    Article  PubMed  Google Scholar 

  21. Murase K, Kumano K, Mannouji T, Yokoe K, Kaneko K, Irie K, et al. Radiographical measurement of anteroposterior instability of the knee joint. Tokyo Hiza Kenkyukai-kaishi 1983;4:179–184 (in Japanese).

    Google Scholar 

  22. Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total nee arthroplasty. J Bone Joint Surg Br 2002;84:50–53.

    Article  PubMed  CAS  Google Scholar 

  23. Figgie HE 3rd, Goldberg VM, Heiple KG, Moller HS, Gordon NH. The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am 1986;68:1035–1040.

    PubMed  Google Scholar 

  24. Mihalko WM, Krackow KA. Posterior cruciate ligament effects on the flexion space in total knee arthroplasty. Clin Orthop 1999;360:243–250.

    Article  PubMed  Google Scholar 

  25. Cope MR, O’Brien BS, Nanu AM. The influence of the posterior cruciate ligament in the maintenance of joint line in primary total knee arthroplasty: a radiologic study. J Arthroplasty 2002;17:206–28.

    Article  PubMed  CAS  Google Scholar 

  26. Tanzer M, Smith K, Burnett S. Posterior-stabilized versus cruciate-retaining total knee arthroplasty: balancing the gap. J Arthroplasty 2002;17:813–819.

    Article  PubMed  Google Scholar 

  27. Kleinbart FA, Bryk E, Evangelista J, Scott WN, Vigorita V. Histologic comparison of posterior cruciate ligaments from arthritic and age-matched knee specimens. J Arthroplasty 1996;11:726–731.

    Article  PubMed  CAS  Google Scholar 

  28. Kadoya Y, Kobayashi A, Komatsu T, Nakagawa S, Yamano Y. Effects of posterior cruciate ligament resection on the tibiofemoral joint gap. Clin Orthop 2001;391:210–217.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Yoshikazu Tsuneizumi, Masahiko Suzuki, Hiroshi Tamai, Tadashi Tsukeoka & Kazuhisa Takahashi

  2. Department of Orthopaedic Surgery, Kashimarosai Hospital, Kamisu, Japan

    Jin Miyagi & Hideshige Moriya

Authors
  1. Yoshikazu Tsuneizumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masahiko Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jin Miyagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroshi Tamai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tadashi Tsukeoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hideshige Moriya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kazuhisa Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Tsuneizumi, Y., Suzuki, M., Miyagi, J. et al. Evaluation of joint laxity against distal traction force upon flexion in cruciate-retaining and posterior-stabilized total knee arthroplasty. J Orthop Sci 13, 504–509 (2008). https://doi.org/10.1007/s00776-008-1269-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00776-008-1269-8

Keywords

Search

Navigation